Patterns of care and outcome in elderly cervical cancer patients: a special focus on brachytherapy.
BACKGROUND
The mean age of the general population has been prolonged and the incidence of cancer in elderly patients has increased. The purpose was to evaluate outcome of brachytherapy (BT) as an integrated part of the treatment of elderly patients with cervical cancer.


METHODS
From November 1997 to January 2006, 1073 patients diagnosed with uterine cervical cancer with stages I-IV (FIGO) have completed BT at the Institut Gustave Roussy. A retrospective analysis was carried out with 113 patients aged over 70-year-old treated by conventional low dose rate (LDR) BT as a part of their treatment.


RESULTS
The median age was 76 years (range, 70.7-94.4). Eighty-four percent of the patients presented a squamous cell carcinoma. Fifty-two percent of the patients were treated by a sequence excluding surgery. The mean 15 and 60 Gy treated volumes were 235 cm(3) (range, 30-371) and 138 cm(3) (range, 81-234), respectively. For the 15 Gy treated volume, the mean ICRU bladder and rectal points were 18.5 Gy (range, 6-35) and 33 Gy (range, 5-63), respectively. For the 60 Gy treated volume, the mean ICRU bladder and rectal points were 33 Gy (range, 12-64) and 41 Gy (range, 23-65), respectively. Rectal, small bowel and urinary tract complications were observed in 25 (22.1%), 5 (4.4%), and in 16 patients (14.2%), respectively. Rectal complications Grades I/II, III/IV and V (fatal) crude incidences were 19.4% (22/113), 1.8% (2/113) and 0.9% (1/113), respectively. Acute toxicity death occurred in one patient with major diarrhea associated with a hemodynamic shock. Small bowel complications Grades I/II and III/IV crude incidences were 3.5% (4/113) and 0.9% (1/113), respectively. Urinary tract complications Grades I/II and III/IV crude incidences were 11.5% (13/113) and 2.7% (3/113), respectively. With a median follow-up of 3.1 years, 10 patients developed distant metastases and 10 others presented local relapses. The 3-year specific overall survival rate was 88.6% (95%CI, 77-92) and the corresponding disease-free survival rate was 81% (95%CI, 72-88).


CONCLUSIONS
Elderly women with cervical cancer tolerated BT well and had excellent local disease-free and specific survival rates. Age did not influence the effectiveness of BT in elderly patients and BT should be considered whenever possible, even in elderly patients presenting with a cervix cancer.
Magné
Nicolas
N
Department of Radiotherapy-Brachytherapy Service, Institut Gustave Roussy, Villejuif, France.
Mancy
Nathalie Casanova
NC
Chajon
Enrique
E
Duvillard
Pierre
P
Pautier
Patricia
P
Castaigne
Damienne
D
Lhommé
Catherine
C
Morice
Philippe
P
Haie-Meder
Christine
C
D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy; D005260:Female; D006801:Humans; D011379:Prognosis; D011879:Radiotherapy Dosage; D017211:Treatment Failure; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000532:radiotherapy*